■Chest Drainage

– Is a closed system designed to drain air or fluid from the

pleural cavity while restoring or maintaining negative
intrapleural pressure needed to keep the lungs properly
expanded.
Chest Tubes
- Are positioned strategically in the pleural space, sutured
to the skin and connected to remove the residual air and fluid
from the pleural or mediastinal space
1. TO CONTINUOUSLY DRAIN FLUID, BLOOD OR AIR FROM THE
PLEURAL CAVITY

2. FOR MEDICATION INSTILLATION

3. TO RESTORE NORMAL INTRAPLEURAL PRESSURE AND

FACILITATE EXPANSION OF LUNG
EQUIPMENT

■STERILE TUBE THORACOSTOMY TRAY INCLUDES:

– DRAPES
– GAUZE SPONES
– 25 GAUGE NEEDLE
– 10 ML SYRINGE
– 22 GAUGE NEEDLE
– #11 BLADE SCALPEL
– FORCEPS
EQUIPMENT

■TWO LARGE CLAMPS

■SUTURE MATERIAL
■LOCAL ANESTHETIC
■CHEST TUBE (APPROPRIATE SIZE) TROCAR,
CONNECTOR
■PERSONAL PROTECTIVE EQUIPMENT
■CHEST DRAINAGE SYSTEM
EQUIPMENT

■STERILE WATER OR SALINE

■SKIN CLEANING SOLUTION
■EXTRA 4X4 GAUZE OT OTHER OCCLUSIVE
DRESSING MATERIAL
■PETROLEUM GAUZE (OPTIONAL)
ACTION
1. IDENTIFY PATIENT
-Perform a complete respiratory
assessment, baseline vital signs
and pulse oximetry.
2. Obtain a chest XRAY. Other
means of localization of pleural
fluid include ultrasound or
fluoroscopic localization.
RATIONALE
■ To ensure correct patient
■ Baseline assessment and vital
signs are essential for any invasive
procedure. Other tube insertion
often causes respiratory distress.
■ To evaluate extent of lung collapse
of amount of bleeding in pleural
space.
ACTION RATIONALE
3. Obtain informed consent
4. Pre-medicate the client for pain ■ To reduce pain
if needed
5. Obtain V/S including oxygen
saturation for baseline data and
then monitor every 4 hours
■ To prevent microorganism from
6. Set up the drainage system entering the system and
( Follow strict surgical technique) subsequently entering the
client’s pleural cavity
WATER SEAL CHAMBER
■ THE TIP OF THE TUBE 2-5CM UNDERWATER
■ IF LESS THAN 2 CM, ADD STERILE WATER
■ NORMAL: INTERMITTENT, GENTLE BUBBLING, OSCILLATION
■ INCREASED CONTINUOUS BUBBLING: AIR LEAK
■ NO MOVEMENT: OBSTRUCTION OR REEXPANSION OF THE LUNGS
 NURSING INTERVENTION
■ KEEP THE SYSTEM CLOSED AND BELOW THE CHEST LEVEL
■ REPORT ANY DRAINAGE THAT’S EXCESSIVE, CLOUDY OR BLOODY
■ AN OCCLUSIVE DRESSING IS MAINTAINED AT THE INSERTION SITE
■ DO NOT STRIP OR MILK THE CHEST TUBE UNLESS SPECIFICALLY
DIRECTED BY THE HCP AND IF THE HOSPITAL ALLOWS IT
■ KEEP A CLAMP; MAY BE NEEDED IF THE SYSTEM NEEDS TO BE
CHANGED AND A STERILE OCCLUSIVE DRESSING AT BEDSIDE AT ALL
TIMES
■ NEVER CLAMP THE CHEST TUBE WITHOUT A WRITTEN ORDER FROM
THE HCP; ALSO DETERMINE HOSPITAL POLICY FOR CLAMPING A CHEST
TUBE
■ ENCOURAGE PATIENT TO PERFORM DEEP BREATHING, COUGHING
EXERCISE
■ WHEN THE CHEST TUBE IS REMOVED, IMMEDIATELY APPLY STERILE
OCCLUSIVE PETROLEUM GAUZE DRESSING OVER THE SITE TO
1. The chest drainage system did not pose a hazard for infection
or loss of air seal to the client
2. The chest tube and drainage system are maintained in a safe
manner
3. The amount of drainage from the chest drainage system was
accurately determined and recorded
 DOCUMENTATION

1. Indicate the type of chest drainage system used.

2. Note presence or absence of leak
3. Record chest tube drainage amount and color.